Senior Product Manager (United States)

The individual will be positioned directly alongside the platform team behind a large-scale Claims Adjudication Platform used by health plans to process and pay claims. The platform is in the middle of a multi-year modernization journey, and this role will help shape and drive that roadmap from the

product side, working day-to-day with the platform's product owners, engineering leads, and health plan stakeholders. This is a hands-on, embedded product role.

Key Responsibilities:

●Partner with the Claims Adjudication Platform's product, architecture, and engineering leads to define, sequence, and prioritize the modernization roadmap.

●Own and groom the product backlog for claims processing modules, writing clear epics, user stories, and acceptance criteria.

●Serve as the claims domain subject matter expert across the team, covering eligibility, benefits configuration, adjudication, pricing, payment, coordination of benefits (COB), subrogation, and appeals/grievances.

●Translate legacy platform business rules and edit logic into modernized, testable requirements without losing regulatory or contractual intent.

●Work directly with EDI transaction flows relevant to claims (837, 835, 276/277, 278) and ensure new capabilities stay compliant with HIPAA transaction standards.

●Facilitate backlog refinement, sprint planning, and other agile ceremonies; keep the team unblocked and focused on the highest-value work.

●Act as the primary point of contact between Simplify Alpha and the platform's leadership team on scope, tradeoffs, and delivery status.

●Define and validate user acceptance testing (UAT) criteria for claims outcomes before release.

●Identify risks and dependencies early, especially where modernization work touches downstream health plan operations.

Required Skills:

●8-12+ years of experience as a Product Owner, Product Manager, or senior Business Analyst in health plan/ payer claims environments.

●Deep, practical understanding of the claims lifecycle: intake, eligibility and benefits, adjudication, pricing, payment integrity, and appeals.

●Working knowledge of core healthcare EDI transactions (837, 835, 276/277, 278) and HIPAA transaction requirements.

●Experience writing detailed user stories and acceptance criteria for complex, rules-heavy systems.

●Comfort working directly with client stakeholders, including client-side product and engineering leadership.

●Solid agile/Scrum fundamentals, including backlog management tools such as JIRA and Confluence.

●Strong written and verbal communication skills; able to translate between business rules, technical

constraints, and regulatory requirements.